Associations between peripheral perfusion disorders, mean arterial pressure and dose of norepinephrine administrated in the early phase of septic shock.

The aim of the study was to explore the correlations between peripheral perfusion, mean arterial pressure and the dose-rate of norepinephrine (NE) infused for the treatment of septic shock. The study is retrospective analysis of data acquired prospectively on 57 patients during the first 24 hours after the occurrence of the shock. Clinical and haemodynamic characteristics, skin perfusion parameters (capillary refill time [CRT], mottling score and temperature gradients) and the dose rate of NE infusion were collected. Negative correlations between mean arterial pressure (MAP) and temperature gradients (core-to-toe: P = .03, core-to-index: P = .04) were found and abnormal CRT was associated with lower MAP (P = .02). The dose rate of NE was negatively correlated with temperature gradients (core-to-toe: P = .02, core-to-index: P = .01, forearm-to-index: P = .008) in the overall population. In patients receiving NE for at least 12 hours, the NE dose rate positively was correlated with the mottling score (P = .006), temperature gradients (core-to-toe: P = .04, forearm-to-index: P = .02, core-to-index: P = .005) and CRT (P = .001). The dose of NE administrated was associated with 14-days mortality (odds ration [OR] = 1.21 [1.06-1.38], P = .006) and with 28-days mortality (OR = 1.17 [1.01-1.36], P = 0.04). In conclusion, the study described the presence of correlations between peripheral perfusion and MAP and between peripheral perfusion and the dose rate of NE infusion.

Usability evaluation of sufentanil sublingual tablet analgesia in patients following Enhanced Recovery After Surgery.

Aim: To evaluate the usability and satisfaction from the sufentanil sublingual tablet system analgesia in the Enhanced Recovery After Surgery pathway in patients, nurses and physical therapist. Materials & methods: A system usability scale was used to evaluate analgesia system in the prospective observational study in spine, orthopedic and thoracic patients. Result: In 111 cases the median system usability scale score was 90 (80-100) (patients) and 72.5 (57.5-82.5) (nurses). The median satisfaction score of the physiotherapist was 90 (75-100). Conclusion: The usability and the satisfaction of the patients and the caregivers from sufentanil sublingual tablet system analgesia in the context of Enhanced Recovery After Surgery protocol were good-to-excellent. The economic potential in the reduction of hospital stay should be studied. Trial registration number: NCT03373851 (ClinicalTrial.gov).

Core-to-skin temperature gradient measured by thermography predicts day-8 mortality in septic shock: A prospective observational study.

BACKGROUND: Septic shock is associated with altered peripheral perfusion. Core-to-skin temperature gradient depends on skin perfusion and microcirculatory function. We hypothesized that a high core-to-skin temperature gradient is correlated with mortality in septic shock. METHODS: We conducted a prospective observational study including 61 patients at the first 24 h of a septic shock in an intensive care unit. During the 24 first hours after norepinephrine administration, we collected clinical and circulatory characteristics, skin perfusion assessment (Capillary refill time (CRT), Mottling score) and we measured skin temperature with an infrared thermographic camera. We measured the Core-to-skin temperature gradient to evaluate if it is a predictor of day-8 mortality. RESULTS: Day-8 mortality was 16.3%. Core-to-index finger temperature gradient >7 °C was associated with day-8 mortality (OR = 18.0, [3.02-346.14], p = 0.002). This association was still significant after adjustment to the SOFA (Sequential Organ Failure Assessment) score. A model including a high SOFA score and a core-to index finger >7 °C was effective to predict day-8 mortality (c-statistic: 0.8735 [0.770-0.976]). Core-to-index finger temperature gradient was correlated with CRT, Mottling Score, and arterial lactate levels. CONCLUSIONS: Core-to-index finger temperature gradient higher than 7 °C predicts day-8 mortality in septic shock and is correlated with other tissue perfusion markers.